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Prostate SBRT With Intrafraction Motion Management Using a Novel Linear Accelerator-Based MV-kV Imaging Method.

Daniel Gorovets1, Sarah Burleson2, Lauren Jacobs1

  • 1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.

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Summary

This study shows that MV-kV imaging effectively manages prostate intrafraction motion during SBRT, improving treatment accuracy. The system corrects for displacements, reducing potential toxicity and enhancing biochemical control.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Prostate stereotactic body radiation therapy (SBRT) requires precise targeting.
  • Intrafraction motion during treatment can compromise accuracy and increase toxicity.
  • Real-time motion management systems are crucial for improving SBRT outcomes.

Purpose of the Study:

  • To evaluate the clinical experience and effectiveness of a linear accelerator-based MV-kV imaging system for intrafraction motion management in prostate SBRT.
  • To assess the impact of MV-kV guided motion correction on treatment delivery and patient outcomes.

Main Methods:

  • 193 prostate SBRT patients treated with MV-kV motion management (40 Gy/5 fractions).
  • Fiducial markers implanted; patients treated with full bladder/empty rectum.
  • Real-time motion tracking using simultaneously acquired kV and MV images during VMAT delivery.
  • Treatment interruptions for repositioning if motion exceeded 1.5-2 mm.

Main Results:

  • Median 1 repositioning per fraction; median treatment time 8.2 minutes.
  • Natural motion >3 mm observed in 32.3% of fractions without correction.
  • Low rates of acute (9.9%/2.0%) and late (11.9%/2.7%) GI/GU toxicity.
  • 99.3% biochemical control rate with one failure.

Conclusions:

  • The MV-kV imaging system effectively manages intrafraction prostate motion during SBRT.
  • This system allows for corrections of prostate displacements, potentially reducing the need for large planning target volume margins.
  • MV-kV imaging enhances the safety and efficacy of prostate SBRT.